The presence of anemia, regardless of the cause or mechanism, in anemia of chronic disease patients adversely affects the quality of life, the outcome of the neoplastic disease and the adherence to treatment. The mechanisms involved in the appearance of anemia in oncologic patients are intricated.
Iron deficiency is a frequent cause of anemia in oncologic patients. In oncologic patients, the prevalent mechanism for iron deficiency is the functional mechanism.
In this case, the iron stores are reduced due to the underlying oncologic condition or due to inflammatory processes associated to cancer treatments.
Iron deficiency in cancer patients is often underestimated, mainly due to the difficulty of defining iron deficiency on the basis of usual laboratory markers. The current therapeutic options of cancer anemia include blood transfusions, iron substitution and erythropoietin-stimulating agents.
Keywords cancer anemia, iron deficiency, anemia treatment Rezumat Anemia este anemia of chronic disease complicaţie frecventă la pacienţii oncologici, fiind întâlnită atât la momentul diagnosticului, cât şi în cursul terapiilor oncologice. Prezenţa anemiei, indiferent de cauză, la pacienţii oncologici are un impact negativ asupra calităţii vieţii, a prognosticului bolii şi a aderenţei la tratament.
Chronic Kidney Disease
Mecanismele de producere a anemia of chronic disease la pacienţii oncologici sunt multiple, putând fi determinată de malabsorbţie şi malnutriţie, sângerare acută sau cronică, inflamaţie sistemică, infiltrare metastatică a măduvei osoase şi de mielosupresie secundară tratamentului.
Deficitul de fier la pacienţii cu cancer este una dintre cele mai frecvente cauze de anemie. Este întâlnit la aproape jumătate din pacienţii cu tumori solide şi hematologice.
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- If you have been diagnosed with chronic kidney disease, commonly known as CKD, your chances of having anaemia increase.
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- Article Recommendations Abstract In this study, different aspects of anemia in chronic kidney disease have been observed, starting from the fact that the severity of anemia is associated with the degree of kidney dysfunction, the main cause being the erythropoietin deficiency, which is synthesized mostly by the kidneys.
La pacienţii cu boală oncologică, mecanismul predominant al deficitului de fier este cel funcţional, disponibilitatea fierului fiind redusă din cauza bolii sau a proceselor inflamatorii legate de terapie.
Deficitul de fier la pacienţii cu cancer rămâne adesea subevaluat, în mare parte din cauza dificultăţii definirii acestuia pe baza markerilor anemia of chronic disease laborator uzuali. Opţiunile terapeutice actuale ale anemiei din cancer includ transfuziile de sânge, substituţia cu fier şi agenţii de stimulare a anemia of chronic disease. Cuvinte cheie anemia în cancer deficit de fier terapia anemiei Introduction Anemia is a frequent complication in cancer patients, both with solid and haematological tumors, and negatively influences the quality of life, the performance status and the prognosis of these patients.
Anemia of chronic disease is important to recognise this condition rapidly and to manage and treat it, and consequently to improve the quality of ganglioni cancer uterin, the tolerability and adherence to citotoxic treatment and the response to oncologic treatments. The data available anemia of chronic disease that the frequency of anemia in cancer patients is very high.
The increased incidence of anemia in oncologic patients is associated with the type of oncologic disease, the advanced stage of the disease and previous treatments.
Deficitul de fier şi cancerul – implicaţii clinice
As for the type of disease, anemia is more common in haematological diseases compared to solid tumors. In solid neoplasia, anemia is commonly associated with bronchopulmonary, breast, gastrointestinal and gynecological cancers 2,3.
Mechanisms involved in anemia and iron deficiency in oncologic patients The mechanisms involved in the occurrence of anemia in cancer patients are multiple and complicated, with several mechanisms responsible for anemia occurring at the same time or at different times 4.
By reviewing the most important mechanisms of anemia, these may be acute or chronic bleeding, commonly found in gynecological tumors and digestive tract.
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The nutritional deficiencies of iron, vitamin B12 and folate, determined by malnutrition or malabsorption, are other common causes of anemia in these patients. Bone marrow infiltration by metastatic disease is frequently found in patients with anemia and breast or prostate cancer.
Deficitul de fier şi cancerul – implicaţii clinice
Other causes in patients with neoplastic disease is the decline in the production of endogenous erythropoietin, seen in patients with cancer and associated chronic renal disease, or due to decreased response to bone marrow erythropoietin 2,5,6. In terms of iron deficiency, it is classified into two anemia of chronic disease — absolute and functional.
Absolute deficiency appears when the iron storage are low and depleted. Functional deficiency is present when anemia of chronic disease reserve is normal or increased, but the disponibility of iron for erythropoiesis is low due to inflammatory processes that cause iron blocking in macrophages and enterocytes. The mechanism of functional iron deficiency in cancer patients is well known.
Iron anemia of chronic disease taken by the transferrin from duodenal enterocytes or macrophages that recycle the iron from aging erythrocytes and it is transported to the bone marrow 8. These mechanisms are controlled by hepcidin, which is an amino acid produced in the liver by peptic hepcidin anti-microbial genes at chromosome 19, in the presence of cancer or chemotherapy-induced inflammation. Hepicidin has the role of maintaining iron homeostasis 9. Hepcidin block the release of iron from the macrophages in the bone marrow by blocking ferroportin, which has the role to transfer the iron from the gastric mucosa to the transferrin.
The functional deficiency of iron occurs following the release of cytokines, especially interleukin-6, in the presence of inflammation, which results in hepcidin production increased in the liver.
High levels of hepcidin are found in many types of hematological and solid cancers. Low levels of hepcidin have been observed in patients with hepatic metastases Evaluation of patients with anemia and iron deficiency Iron deficiency in cancer patients is a common state.
ANEMIA Symptoms, Causes & Treatments
But it is very difficult to recognize paraziti u stolici terapija. Evaluating the profile of patients with iron deficiency, data available from studies show that patients with tumors of the colon, rectum, pancreas and pulmonary syndrome have a very frequent iron deficiency.
Also, patients with advanced disease and chemotherapeutic treatment have iron deficiency.
Tema plagiatului este tot mai mult discutată în ultima vreme. Anemia of chronic disease unor programe performante de căutare și identificare a similitudinilor între texte [ The differential diagnosis of this entity remains one of the most encountered problems: from thalassemia, neoplasia, malabsorbtion syndrome to chronic kidney disease under hemodialysis. Case report: This case report describes clinical and paraclinical features of a year-old patient with multiple comorbidities and iron deficiency anemia.
It may be present even in the absence of anemia, it can influence the performance status of patients and may cause fatigue, an important and frequent sign anemia of chronic disease. In healthy people, ferritin values show the status of iron stores. Other parameters, such as transferrin saturation, the percentage of hypochromic erythrocytes, the soluble transferrin receptor and the reticulocyte hemoglobin content, show the amount of iron that is biologically available.
All these markers are modified in cancer patients. Particularly ferritin, which is an anemia of chronic disease phase protein, may not properly reflect iron deposits in cancer patients who have an inflammatory status.
Why are people with Chronic Kidney Disease (CKD) at Risk of Iron Deficiency?
Transferrin saturation assessment is recommended, but it has also limitations in cancer patients, because of the presence of inflammation or malnutrition that causes transferrin levels to be reduced, so normal or elevated false values may occur 14, The measurement of circulating hepcidin levels appears to be a useful tool in the diagnosis of iron deficiency in these patients, but is still under evaluation Moreover, the functional iron deficiency is difficult to diagnose and often remains unnoticed and consequently untreated.
It is therefore important to evaluate in details the iron profile of the patients, in order to highlight the presence of iron deficiency.
Additional studies are also needed to evaluate more precisely the biomarkers that can be used in the diagnosis of iron deficiency, especially the functional deficiency. Conflict of interests: The authors declare no conflict of interests.
The European cancer anaemia survey ECAS : A large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Pharmaceuticals Basel, Switzerland.
Grotto HZ. Anaemia of cancer: An overview of mechanisms involved in its pathogenesis.